Business Insurance

Page 1 of 19

  1. This policy is only available to Australian domiciled persons.
  2. Where did you hear about Action Entertainment Insurance?
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  3. Have you previously spoken to an Action Representative regarding this quote?(*)
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  4. Name of representative?
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  5. Name of Insured(*)
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  6. ABN
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  1. Are you completing this proposal as a client or broker on behalf of the client?(*)
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  2. Brokerage Name (*)
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  3. Contact Name(*)
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  4. Postal Address(*)
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  5. Suburb(*)
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  6. State(*)
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  7. Postcode (*)
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  8. Phone Number(*)
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  9. Fax Number
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  10. Email Address (*)
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  11. Clients Address (*)
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  12. Clients Website Address
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  1. General Information
  2. Business Activities to be Insured
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    Please describe your activities in as much detail as possible.
  3. How many years experience do you have in this field and / or how long has your business been operating for?
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  4. Period that cover is required
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  5. Start Date(*)
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  6. Please advise the estimated turnover / wages of your business for the next 12 months?
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    If cover is only required short-term, please advise for turnover or budget for the short-term period
  7. Number of Employees
  8. Total Number of Fulltime staff
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  9. Total number of part-time / casual staff?
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  10. Do you use contractors / sub-contractors?(*)
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  11. What activities will your contractors carry out?*
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  12. Estimated payments to contractors / sub-contractors?
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  13. Do you insist on your contractors / sub-contractors carrying their own public liability insurance?
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    This will be a condition of cover
  1. Duty of Disclosure and Claims Information
  2. Have you or any partners, shareholders or directors of the business:
  3. Ever had an insurance policy cancelled, declined or terms imposed?
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  4. Please provide details
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  5. Ever been bankrupt?
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  6. Please provide details
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  7. Ever had a company or business which became insolvent or subject to any form of insolvency administration (e.g. Liquidation or receivership)?
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  8. Please provide details
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  9. Been convicted of a criminal offence within the past 5 years?
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  10. Please provide details
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  11. Been liable for any civil offence or pecuniary penalty (exceeding $ 5,000)?
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  12. Please provide details
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  13. Any other matters you should disclose?
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  14. Please provide details
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  15. Have you or anyone else to be covered under this policy, had any claims or uninsured losses in the last 5 years?
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  16. Please provide details
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  1. Situation Details
  2. Situation Address(*)
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  3. Construction Details:
  4. Year Built?(*)
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  5. Number of stories?(*)
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  6. What is the construction of the floors?(*)
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  7. What is the construction of the wall?(*)
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  8. Please specify(*)
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  9. What is the construction of the roof?(*)
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  10. When was the building last rewired?(*)
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  11. When was the building last replumbed?(*)
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  12. How much Expanded Polystyrene (EPS) does the premises contain (e.g foam insulation)?(*)
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  1. Fire Protection & Security Details
  2. Please select all fire protection applicable(*)










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  3. Please select all security protection applicable(*)











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  4. If applicable please specific the type of monitored alarm
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  1. Other Situation Details
  2. Is there an ATM on the premises?(*)
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  3. Where is the premises located?(*)
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  4. Is the premises connected to town water?(*)
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  5. Type of Fire Brigade(*)
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  6. Do you store flammable goods?(*)
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  7. What are the goods?(*)
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  8. What quantity?(*)
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  9. Are substances stored in accordance with Australia Standards and Local/State government regulations?(*)
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  10. Does your premises contain multiple occupancy of tenants?(*)
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  11. Is your premises more than 50% vacant? (*)
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  12. Is the building heritage or national trust listed? (*)
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  1. Do you require cover for Fire & Perils Cover on Property (Building, Contents &/or Stock)?(*)
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  2. Sums Insured
  3. Building
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  4. Contents
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  5. Stock
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  6. Specified Items, please specify
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  7. Optional Extensions
  8. Accidental Damage
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  9. Extra Cost of Reinstatement
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  10. Removal of Debris
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  11. Rewriting of Records
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  12. Is Flood cover required?(*)
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  13. Note: Underinsurance applies to this section of the Policy. Please make sure your declared values represent the brand new replacement cost of your assets.
  1. Do you require cover for Business Interruption?
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  2. Type of Cover(*)
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  3. Sum Insured(*)
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  4. Indemnity Period(*)
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  5. Please specify
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  6. Additional covers (Sums Insured)
  7. Additional Increase in Cost of Working
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  8. Accounts Receivable
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  9. Claims Preparation Costs
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  10. Loss of Rent Receivable
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  11. Payroll
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  12. Optional Extensions
  13. Extensions to other premises?
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  14. Number of other premises?
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  15. Premise 1
  16. Supplier or Customer?
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  17. Name
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  18. Address/Suburb/State/Postcode/Country
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  19. Goods supplied
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  20. Percentage of Dependency
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  21. Premise 2
  22. Supplier or Customer?
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  23. Name
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  24. Address/Suburb/State/Postcode/Country
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  25. Goods supplied
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  26. Percentage of Dependency
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  27. Premise 3
  28. Supplier or Customer?
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  29. Name
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  30. Address/Suburb/State/Postcode/Country
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  31. Goods supplied
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  32. Percentage of Dependency
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  33. Premise 4
  34. Supplier or Customer?
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  35. Name
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  36. Address/Suburb/State/Postcode/Country
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  37. Goods supplied
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  38. Percentage of Dependency
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  39. Premise 5
  40. Supplier or Customer?
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  41. Name
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  42. Address/Suburb/State/Postcode/Country
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  43. Goods supplied
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  44. Percentage of Dependency
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  45. Premise 6
  46. Supplier or Customer?
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  47. Name
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  48. Address/Suburb/State/Postcode/Country
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  49. Goods supplied
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  50. Percentage of Dependency
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  51. Premise 7
  52. Supplier or Customer?
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  53. Name
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  54. Address/Suburb/State/Postcode/Country
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  55. Goods supplied
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  56. Percentage of Dependency
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  57. Premise 8
  58. Supplier or Customer?
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  59. Name
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  60. Address/Suburb/State/Postcode/Country
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  61. Goods supplied
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  62. Percentage of Dependency
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  63. Premise 9
  64. Supplier or Customer?
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  65. Name
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  66. Address/Suburb/State/Postcode/Country
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  67. Goods supplied
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  68. Percentage of Dependency
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  69. Premise 10
  70. Supplier or Customer?
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  71. Name
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  72. Address/Suburb/State/Postcode/Country
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  73. Goods supplied
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  74. Percentage of Dependency
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  1. Do you require cover for Theft/Burglary?(*)
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  2. Sums Insured
  3. Contents – including stock
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  4. Contents – excluding stock
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  5. Stock In Trade
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  6. Cigarettes & Tobacco
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  7. Alcohol
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  8. Specified Items, please specify
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  9. Additional Benefits
  10. Damage to Business Premises
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  11. Damage to Rented Premises
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  12. Do you require cover for Theft without Forcible and Violent Entry / Theft of property in open air?
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  13. Specify amount
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  1. Do you require cover for Money?(*)
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  2. Blanket cover
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  3. OR
  4. Specified Covers
  5. Money in Transit
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  6. Money on Business Premises - during business hours
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  7. Money on Business Premises - outside business hours
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  8. Money in locked safe or strongroom
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  9. Money in private residence
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  10. Do you require cover for damage to safe or strongroom?
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  11. Sum Insured
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  1. Do you require cover for Glass?(*)
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  2. External Glass(*)
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  3. Internal Glass(*)
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  4. Please describe the type and size of glass to be covered
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  5. Do you require cover for advertising signs?
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  6. Please specify sum insured
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  1. Do you require cover for Liability Insurance?(*)
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  2. Limit of Liability (*)
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  3. Do you require cover for Property Owners Liability Only?(*)
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  4. Do you required cover for Property in your Physical,& Legal Control?
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  5. Please specify limit
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  6. Please provide estimated figures for the next 12 months
  7. Turnover
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  8. Wages
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  9. Will you be signing any contracts that contain hold harmless of indemnity agreements?
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    Note – a hold harmless or indemnity agreement is whereby one party assumes the liability of risks of another party under contract. Your public liability policy is to cover your legal liability and no one else’s, therefore claims arising from these agreements are excluded. In some circumstances, your policy can be amended to include cover for these agreements providing your Insurer can review them and agree to their content. If you sign these agreements without first referring them to your Insurer, you may not be covered in the event of a claim.
  10. Please provide copies of such agreements
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  11. Will you be importing or exporting any Products to/from Australia?
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  12. Please provide details including type of products, values and countries.
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  1. Do you require cover Employee Dishonesty?(*)
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  2. Sum Insured Limit any one employee or group of employees
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  3. Sum Insured Limit any one period of insurance
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  1. Do you require cover for Machinery Breakdown?(*)
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  2. Total value of all Plant & Machinery to be covered
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  3. Please select type of Plant & Machinery to be covered










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  4. Air Conditioners kW/HP
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  5. Electric Motors kW/HP
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  6. Other machinery details
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  7. Limit any one loss
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  8. Other loss details
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  9. If cover is required for specified items, please list items including kW/HP & value.
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  10. Additional Covers
  11. Deterioration of Stock
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  12. Increase in Cost of Working
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  1. Do you require cover for Electronic Equipment?(*)
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  2. Please select category/s for your equipment.








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  3. Limit any one loss
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  4. OR
  5. Please provide list of specified items include description and sum insured
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  6. Cover Options
  7. Do you require cover for any of the additional covers.
  8. Electronic Data
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  9. Electronic Data Media
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  10. Restoration of Computer Data
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  11. Increased Cost of Working
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  12. Gross Profit
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  13. Indemnity Period
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  14. Other Period
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  1. Do you require cover General Property?(*)
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  2. Please select category/s for your equipment.







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  3. Sum Insured
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  4. OR
  5. Please provide list of specified items include description and sum insured
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  6. Please select type of cover required




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  7. Other Cover Options



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  1. Do you require cover for Tax Audit?(*)
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  2. Has the Business &/or any director who will receive protection under this section had any previous Tax Audits?
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  3. Please provide details
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  4. Cover Type
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  5. Tax Audit Sum Insured
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  6. Other details
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  7. Please advise number of directors
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  8. Name of Director 1
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  9. Suburb/State/Postcode
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  10. Name of Director 2
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  11. Suburb/State/Postcode
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  12. Name of Director 3
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  13. Suburb/State/Postcode
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  14. Name of Director 4
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  15. Suburb/State/Postcode
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  16. Name of Director 5
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  17. Suburb/State/Postcode
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  18. Other Information
  19. Do you wish to provide any additional Information?(*)
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  20. Please provide details or attach document below
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  21. Upload document
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  1. Disclaimer

    Privacy Policy

    At Action Entertainment Insurance Pty Ltd Corporate Representative No. 237473 as an authorised representative of Action Insurance Brokers P/L AFS 225047, we are committed to protecting your privacy in accordance with the Privacy Act 1988 (Cth) and the Australian Privacy Principles. This Privacy Policy describes our current policies and practices in relation to the collection, handling, use and disclosure of personal information. It also deals with how you can complain about a breach of the privacy laws and how you can access the personal information we hold and how to have that information corrected.

    Please visit https://www.entertainmentinsurance.net.au/privacy-policy to read our full privacy policy.

    Your Duty of Disclosure

    When entering into a contract of general insurance you need to tell us

    Before you enter into a contract of general insurance with us, you have a duty, under the Insurance Contracts Act 1984, to disclose to us every matter that you know, or could reasonably be expected to know, is relevant to our decision whether to accept the risk of the insurance and, if so, on what terms.

    When entering into a subsequent or renewing a contract of general insurance

    You have the same duty to disclose any matter to us before you renew, extend, vary or reinstate a contract of general insurance, which may affect our decision to insure you.

    What you are not required to disclose

    Your duty does not require disclosure of any matter:

    1. 1.That diminishes the risk to be undertaken by us;
    2. 2.That is of common knowledge;
    3. 3.That we know or, in the ordinary course of our business, ought to know;
    4. 4.Where compliance with this duty is waived by us.

    Non disclosure and its consequences

    If you fail to comply with your duty of disclosure at law, and/or have not answered our questions honestly and not told us what you, as a reasonable person in the circumstances would have answered, we may be entitled to reduce our liability under the contract in respect of a claim or may cancel the contract.

    Fraudulent non disclosure and its consequences

    If your non disclosure is fraudulent, we may also have the option of avoiding the contract from its beginning.

    Subrogation

    You may prejudice your rights with regard to a claim if, without prior agreement from the Insurer, you make agreement with a third party that will prevent the Insurer from recovering the loss from that, or another party.

    Your policy contains provisions that either exclude the Insurer from liability or reduce their liability, if you have entered into any agreements that excludes your rights to recover damages from another party in relation to any loss, damage or destruction which would allow you to sustain a claim under this policy.

  2. I have read and understand the Statutory Notices:(*)
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  3. I have read and understand the Subrogation Clause(*)
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  4. Please enter the code shown below(*)
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Action Entertainment Insurance Pty Ltd ABN 20 103 891 265 Corporate Representative No. 237473 as an authorised representative of Action Insurance Brokers P/L ABN 39 080 844 426 AFS 225047

Privacy Policy
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